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308 


PROGRESS OF MEDICAL SCIENCE 


trophic influence apparently exerted by these glands upon osseous 
development. The patient was from birth of larger and coarser build 
than her brothers and sisters, so that it 3eems probable that she had 
a congenital tendency to gigantism; in other words, that the delicate 
balance between the secretions of the ductless glands governing stimu¬ 
latory and inhibitory functions with respect to growth were abnor¬ 
mally unstable, so that the ablation of one important set of glands of 
internal secretion—the ovaries—was sufficient to upset this balance 
and to cause a hyperactivity of certain other glands, perhaps chiefly 
the hypophysis, without, however, causing a demonstrable increase 
in the size of this. 


Is Uterine Carcinoma Ever Cured by Curettage?—An interesting 
case, which brings up this question, is reported by Hess ( Deutsch. 
med. IVoch., 1913, xxxix, 1038). A woman, aged forty-one years, pre¬ 
sented herself for treatment, complaining of loss of weight and strength, 
hemorrhage lasting for three months, and foul discharge. No tumor 
was palpable, but microscopic examination of tissue removed by 
curettage showed a typical adenocarcinoma corporis uteri, this diag¬ 
nosis being confirmed by a number of thoroughly competent patholo¬ 
gists. Radical operation was therefore advised, but was absolutely 
refused by the patient, whose sister had recently died following oper- 
tion for an abdominal cancer. The patient has been kept under 
observation for four years; the hemorrhage and discharge have entirely 
ceased, she has gained in weight and strength, and is now apparently 
in perfect health. In view of the clinical symptoms and the micro¬ 
scopic examination of the curettings there can be no reasonable doubt 
that the case was really one of beginning carcinoma of the uterine 
body. To determine just what has taken place, is, however, extremely 
difficult. Four chief possibilities come into consideration: (1) Has 
the malignant tumor undergone spontaneous retrogression and even¬ 
tual disappearance? (2) Is the cure only apparent; i. c., is the malig¬ 
nant process still present in the body in a latent condition, causing 
at present no symptoms whatever, but to reappear at some future 
time? Such cases have been reported. (3) Was the small area of 
beginning malignancy confined solely to the endometrium and com¬ 
pletely removed by the curette, leaving nothing but normal tissue 
behind? (4) Was the major portion of the tumor removed, and the 
scattered remnants so damaged that they fell an easy prey to the 
hemorrhage caused by the curettage, undergoing lysis and ultimate 
disappearance? Hess admits his inability to determine by which of 
the processes the clinical result has been brought about, but thinks 
that several of them may have acted together. In a note appended 
to the above report, a somewhat similar ease is reported by v. Hanse- 
mann, who was one of the pathologists to confirm the diagnosis. In 
this instance, a curetteinent was done upon a girl, aged seventeen 
years, on account of a suspicion of malignancy. The curettings 
showed an unmistakable squamous-cell carcinoma of the uterine 
body; the uterus was therefore removed, but serial sections of prac¬ 
tically the entire endometrium failed to reveal a single carcinomatous 
area. A third case of this nature is reported by Sthatz ( Zeniralbl . /. 
Gyn., 1913, xxxvii, 1141). The patient had a constant fear of develop- 



OPHTHALMOLOGY 


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ing uterine cancer, from which disease her mother had died; she had 
therefore had a curettement performed every two years for micro¬ 
scopic diagnosis. About the third or fourth time the tissue removed 
showed definite malignancy, the diagnosis being confirmed by Ruge, 
but no trace of carcinoma could he found in the extirpated uterus, 
even after the most careful search. Although these 3 cases, and 
other occasional ones that have been reported in the literature, seem 
to indicate that in exceptional instances a simple curettage may be 
really curative of cancer of the uterine body, such instances are so 
exceptional that great harm would be done, ns all the authors quoted 
emphasize, were confidence to be placed in its occurrence; such cases 
are interesting curiosities, but are in no sense to bet considered os 
justifying a retreat from the universally accepted principle of radical 
removal of carcinomatous tissue when this is possible. 


OPHTHALMOLOGY 


UNDER THE CHARGE OP 

EDWAHI) JACKSON, A.M., M.D., 

. DENVER,COtOHADO, 

AND 

T. B. SCIINEIDEMAN, A.M, M.D., 

VHILADEDEBIA. 

Traumatic Glaucoma,—0. and H. Fromaget (Anna}. d’Oculistiquc, 
January, 1913, p. 1) have made an interesting study of the occurrence 
of glaucoma after contusions of the eyeball without rupture of its 
coats. They conclude; that such traumatism occasionally, though 
very rarely, determines an acute glaucomatous condition which may 
immediately follow the injury or be delayed several weeks. This 
condition differs in nowise clinically from ordinary idiopathic acute 
glaucoma; accordingly they designate it as essential traumatic glaucoma. 
A second variety whose clinical identity with spontaneous glaucoma 
is not so well established, is observed to follow post hemorrhagic 
traumatisms; of this there are two forms; in one the hypertension is 
the essential factor, the hemorrhage being slight; in the other there 
is present with the hypertension a veritable inundation of the globe 
with blood. A third variety which may be termed symptomatic or 
false glaucoma occurs, in which the glaucomatous state is a sequel 
to other lesions, especially luxations or subluxations of the lens, or 
tears of the ciliary region with more or less extensive ruptures of the 
zonula. The latter make up by far the most numerous of the cases 
published under the name of traumatic glaucoma. The lesions to 
the lens system in these cases being nt times difficult of diagnosis, 
may escape recognition and the case come to be regarded ns one of 
pure glaucoma. Nothing can be affirmed as to the identity of origin